What is the first line treatment for acute salicylate overdose?

In the case of acute salicylate overdose, the first-line treatment is urinary alkalinization. This approach is primarily effective because salicylates are weak acids, and by alkalinizing the urine, you increase the ionization of the salicylates, which reduces their reabsorption in the renal tubules. Consequently, this enhances the excretion of salicylates from the body.

Urinary alkalinization is achieved through administering bicarbonate, which raises the pH of the urine, making the drug more hydrophilic and promoting its elimination. This method addresses both the toxicity associated with salicylate accumulation and helps to mitigate the effects of overdose more effectively than other methods.

Other treatments, while important in certain scenarios, are not the first line for acute salicylate toxicity. Activated charcoal, for instance, is sometimes administered to adsorb the salicylate if it's within the timeframe for effective intervention, but it is not as effective in speeding up elimination. Gastric lavage might be used, particularly in life-threatening cases, but it is typically reserved for early presentations and is less commonly recommended due to potential complications. Whole bowel irrigation can be utilized for certain poisons but is not considered standard for sal